Parenteral Manual

Fat emulsion 20%

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Intravenous nutritional therapy, caloric agent
Original Date: 
August 2005
Revised Date: 
May 2017
  • Source of calories and essential fatty acids for patients needing parenteral nutrition
  • Treatment for local anesthetic-induced cardiac arrest when standard resuscitation methods fail to re-establish sufficient circulatory stability
  • Treatment for management of hemodynamic instability due to lidocaine toxicity
Reconstitution and Stability: 
  • Store at room temperature, avoid freezing
  • Partly used bags should be discarded
  • DO NOT USE if emulsion is oiling out

- Solutions Compatible: D50W, 0.9% NaCl, ringer's lactate, amino acid solution

- Additives/Above Cassette Compatible: heparin (1-2 units/mL)

- Y-site Compatible: refer to Lexi/Micromedix IV compatibility information

- Incompatible: refer to Lexi/Micromedix IV compatibility information


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

IV Direct


IV Intermittent Infusion NO
IV Continuous Infusion YES,  via peripheral or central vein
Infusion rate: do not exceed 0.25 g/kg/hour (do not exceed 1.25 mL/kg/hour of 20% solution)

(For neonatal dosages, refer to Neonatal IV Drug Manual.)


  • Initiate at 0.5-1 g/kg/day;
  • Increase by 0.5 g/kg/day
  • Maximum: 3 g/kg/day


  • Initiate at 1 g/kg/day;
  • Increase by 0.5-1 g/kg/day
  • Maximum: 2.5 g/kg/day

- 30-35% of total daily calories should come from fat
- Maximum of 60% of total daily calories from fat emulsion

Treatment for local anesthetic-induced cardiac arrest/hemodynamic instability       

  •  20%  IV dose regime: 1.5 mL/kg over 1 minute  - follow with an infusion at rate of 15 mL/kg/hr                                        
    -  continue infusion until hemodynamic stability is restored      
    -  usual maximum infusion time 30 minutes and maximum total dose of 10 mL/kg      
Potential hazards of parenteral administration: 
  • Cyanosis, flushing, chest or back pain
  • Thrombophlebitis
  • Sepsis
  • Hyperlipidemia, hepatomegaly
  • Dyspnea
  • Fever, chills
  • Nausea, vomiting


  • 20% lipid = 2 Kcal/mL
  • Monitor serum triglycerides and free fatty acids
  • May be administered both peripherally and centrally
  • Contraindicated in pancreatitis with hyperlipidemia, lipoid nephrosis, and severe egg or soybean allergies
  • Use with caution in patients with severe liver damage, pulmonary disease, anemia, or blood coagulation disorder, and in jaundiced patients
  • Refer to SMOF monograph for SMOF information

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